ABSTRACT Background Maternal mortality remains a major global public health concern, with the highest burden in low‐ and middle‐income countries. Despite global progress, preventable causes such as hemorrhage and hypertensive disorders continue to contribute significantly to maternal deaths. Bhutan, a resource‐constrained and mountainous country, historically faced substantial challenges in ensuring equitable access to maternal healthcare. Objectives This study reviewed the trends in maternal mortality in Bhutan from 1985 to 2024 and described the key health system interventions and milestones that contributed to the country's achievement of Sustainable Development Goal 3 (SDG‐3). Methods This was a narrative national review based on secondary data from government reports, national health bulletins, and international databases. Trends in maternal mortality ratio (MMR), causes of maternal death, and health system developments were analyzed over time. Results Bhutan's maternal mortality ratio declined dramatically from 969 per 100 000 live births in 1985 to 53 per 100 000 live births in 2024, achieving the SDG‐3 target ( 98%), high antenatal care coverage (98.5%), and implementation of key programs such as the Safe Motherhood Initiative, Emergency Obstetric and Newborn Care (EmONC), and Maternal and Perinatal Death Surveillance and Response (MPDSR). Over time, the leading causes of maternal death shifted from direct obstetric causes, particularly postpartum hemorrhage, to indirect medical conditions. Bhutan has entered Stage III of the obstetric transition, characterized by low maternal mortality and improved health system performance. Conclusion Bhutan has made remarkable progress in reducing maternal mortality and successfully achieved SDG‐3 ahead of schedule. Continued efforts should focus on improving the quality of care at health facilities, addressing indirect causes of maternal death, strengthening workforce retention, and expanding preconception care services to sustain and further advance maternal health outcomes.
Dorjey et al. (Mon,) studied this question.